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ever�tt APPLICATIQN FOR �UB�IC WORf�S PER11AlY <br />� TYPB or Pfin� CIBadY wllh Ink " <br />PRESS HARD - YOU ARE MAr(ING COPIES � � �� y <br />PUBLIC WORKS PERMIT NO. _�' <br />EVERETT, WASHINGTON ,�/ � BLDG. DEPT. NO.p�'S� <br />� OWNER ❑ AGENT DATE / a�~� 2- <br />�-1 F' / <br />APPUCANT/FIRM REPRE:iENTED _ �/ � �n� �LrZ'' T'`" C��t`h u'° �_ ____ <br />ADDRESS C✓G' L' .�+�- cf-t.c� // CITY v"U` �GG TELFPHONE <br />. . �. —. r' •-�- <br />HEREBY APPLIE� �OR PLRMISSION TO <br />ATTHE FOLLOWING LOi:ATION �—�O f-�L�- os- i --,.��� GZ�C��__ <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. " Topographic changes requiring cuts and fills <br />` Outline and dimensions of existing and other than normal foundation. <br />proposed structures. ' On-site drainac�e systems when required. <br />' Existing and proposed utilities. ' Erosion control methods when required. <br />' Centerline of abutting right of way. " N�rt j�row <br />`�/�c� �-`d�-�!� � � G�� _-�= Li, <br />Signntare ol Applicant <br />PU�3LIC WORKS PcRMIT � <br />CONDITIONS: _ _ <br />'.'_'_" ._... .����. �CUI,i'�C� . /lf�Ci!l�r�f�MN��'�' . L.'�'/ . . `✓i'� - J.'.'/�-_ <br />. . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />.... . . . . . . . . . . . . . . . . . . . . . . . . . . <br />. : .. _. . . _ ... _ .__' . _.. .__ .... . . .. . . . . . . . . ... ... ..... . . . . .._... _.... _ . <br />. � . . . . . . . . . . . . � . . . . . . � . . . . . . . . . . . . . : . . I . <br />�I . . � 1 . .. . ... . . . � � . . . . . . . . . . . . .. . . . . . � i , . . . . . � . . . . . . <br />. . <br />� . <br />` � , i .. ' � . I � � I _ ....__ _.. ....__ _...._ � ._.._ . . . . . . .... . . <br />I � � ! : <br />�� r `�j__�.'_ � �. : .� i � . ( . . i . . . ? . . . . � . . . i . <br />^1 �.. f�..j..: ..i ..:. ..._,. <br />. : ,(%a� /Hr/'�-?`. e� �C�1 <br />_._. ._. ._.__ <br />; . : � . . , � , , . , . The untler..ignetl owner hereby agrees to hald and save harmless <br />�� , ,+. Ihe Cily ol Everett rrom any ana ail claims lor damages, costs, <br />. . . . . . . . . . . . . . . . . . . . . . . expenses, or causes of action Ihat may arise bacnuso ol installation <br />. . . . . . .. . . . . . . . . . . . . . . . . . . and maintenance ol the improvement or othor righ4o4way use <br />. . . . . . . . . . . . . . . - . . . heroto applied for and lurlher agrees �o remove same upon nolice <br />•�� � - � Irom Ihe City and to replace OuDlic pmperty damagetl thereb7. <br />` `��l i: � ,5 --' -�' �-'— <br />_z <br />PERMIT IS VALID FOR 1 YEAR <br />EXPIRATION `� � �J `� � <br />ACKNOWLEDGEMENT OF CONDITIGNS <br />�z- � a_� �' c, z,F._, L�.� � <br />SIGNATUREOFAPPLICANT DATE <br />CALL FOR INSPECTION <br />POST ON 259-8811 <br />JOBSlTE 24HRS.BEFORECONSTRUCTION <br />13 <br />\ <br />� <br />3 <br />� <br />